Millions of people living in Germany could soon be paying significantly more for health insurance. According to an exclusive report by Handelsblatt, coalition discussions are currently under way about ending premium‑free health and long‑term care insurance for non‑working spouses.
Under the reported plans, spouses who are currently insured for free would instead have to pay a minimum monthly contribution of around €225 – roughly €200 for statutory health insurance and €25 for long‑term care insurance.
Exceptions would apply for people caring for children under six or relatives in need of care.
Health Minister Nina Warken – of the conservative Christian Democrats (CDU) – has so far declined to comment on the report, saying she wants to wait for the findings of the Health Finance Commission.
The commission is due to present its first recommendations at the end of March.
What the proposed change could mean
If the Handelsblatt report proves accurate, the financial impact on some households would be substantial.
A flat €225 monthly charge would amount to €2,700 per year, regardless of household income.
Under the current rules in Germany, spouses and children can be insured free of charge under a working family member’s statutory health insurance policy (GKV), provided certain conditions are met.
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For spouses, this includes earning no more than €603 per month, not being primarily self‑employed and not being privately insured.
Roughly three million adults are covered through this "family insurance" system, many of whom could potentially be affected by the proposed change.
Supporters of the current system argue that scrapping free spousal cover would hit traditional families, carers and low‑income households hardest, regardless of their ability to pay.Â
For example, the GKV‑Spitzenverband – the umbrella organisation representing statutory health insurers – argues that the change would undermine the principle of solidarity which underpins Germany’s statutory health insurance.
By contrast, economists quoted in Focus magazine claim that abolishing free co‑insurance could encourage more people into paid employment.
What is the Health Finance Commission – and why does it matter?
There is widespread agreement in Germany that the country’s current health‑care financing model is unsustainable in the long term – even if there's disagreement over how the problem should be addressed.
The recommendation to scrap co-insurance for spouses is expected to feature alongside a number of other proposed reforms when the Health Finance Commission (FinanzKommission Gesundheit) publishes its first report – focussed on short term measures – at the end of this month.
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Set up by the Ministry of Health in 2025, the commission consists of ten experts drawn from the fields of economics, medicine, social law and ethics and prevention. Its task is to analyse where costs in the statutory health system are rising fastest and to propose measures designed to stabilise contribution rates.
The commission – which is an advisory body with no legislative power – is due to produce a second report on structural reforms by the end of the year.
But even before the commission publishes its first report, trade union Verdi has said the direction of travel is already clear: higher individual contributions, tighter benefits and new ways of raising money within the existing contribution system, rather than a fundamental rethink of how healthcare is financed.
According to the union, the reforms being discussed or signalled include higher co‑payments for patients, new or revived user fees, restrictions on sick pay and sick leave, and measures designed to push more people into paid work in order to increase contribution income.
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Scrapping free spousal cover would fit neatly into this logic because it would raise revenue without requiring the state to draw on other sources of funding.
Verdi is sharply critical of the fact that none of the reforms reportedly under discussion involve taxing wealth, capital income or rents, or otherwise broadening the revenue base beyond wages and salaries.
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